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    Edward C. Lanssens   
503-947-7742   

Electronic Data Interchange (EDI)



EDI Medical Bill Reporting:
 
  Send us an email about EDI Medical Bill Reporting questions
     
  Medical EDI Traffic Report
 
  Oregon EDI Medical Bill Reporting Implementation Guide 12/14/10
(Includes ANSI loop, segment, data element summary, and file naming instructions.)
      To obtain Expanded List of Valid Revenue Codes (NUBC web page)
      List of insurers required to submit medical billing data (now Bulletin 359)
      List of taxonomy codes that do not require a diagnosis code
 
  Frequently asked questions for EDI medical bill reporting
 
      Medical Bill Data Element Requirement Table (OAR 436-160-410 see page 10)
 
  EDI Medical Billing Trading Partner Profile Form: Trading Partner Profile (Form 4015)
 
  Oregon Data Elements by Source table
 
  Obtain IAIABC EDI Medical Implementation Guide
 
  Current Rules affecting EDI medical bill reporting:
      Division 160 - Electronic Data Interchange Rules
       
  Release 1.1 to Release 2.0 transition information
      Oregon Medical Bill Data Electronic Data Interchange (EDI) Guide (Effective 7/1/2014)
      Division 160 Electronic Data Interchange Rules (Effective 7/01/14)
      Medical Bill Data Element Requirement Table - Appendix A (Effective 7/01/14)
      Oregon Medical EDI Data Element Requirement Conditions - Appendix B (Effective 7/01/14)
      Edit Matrix (By Segment) New (3/19/2014)
      Edit Matrix (Numerical) New (3/19/2014)
      Medical Release 2 Population Restrictions Table New (3/19/2014)
      Medical 2.0 Valid Value Table New (3/19/2014)
      Medical Release 2.0 Detail Transaction Sequencing New (3/19/2014)
      Medical Release 2.0 Summary Sequencing Table New (3/19/2014)
      Medical Reporting Event Table New (3/19/2014)
       
  Transition to ICD-10 Codes (Information)
    The list of required Oregon hospitals can be found in Oregon Administrative Rule 436-009, Appendix A.
  Oregon critical access hospitals are not required to report the MS-DRG codes on their inpatient bills. [Most Oregon hospitals are required to report the appropriate MS-DRG codes on their workers' compensation inpatient hospital bills. (4/1/11)]
 

EDI Proof of Coverage Reporting:
  Division 162 Electronic Data Interchange; Proof of Coverage Rules
  Proof of Coverage Data Element Requirement Table (see 436-162-0310, Appendix A, page 11)
  Oregon EDI Implementation Guide for Proof of Coverage - December, 2010
  Proof of Coverage-Edit matrix
  Trading Partner Agreement, (Filing Guaranty Contracts), Form 4820; for information contact:
      EDI Coordinator: 503-947-7742; E-mail: edinews.wcd@state.or.us
      Oregon Proof of Coverage EDI Insurer Profile Form 4821
  Insurer registration requirements
  Employee Leasing Policy Identification
 

eBilling for Workers' Compensation
  Proposed ebilling rules, companion guide, resources, and more
 

Other resources:
 

HIPAA

 

International Association of Industrial Accident Boards and Commissions (IAIABC)

 

National Council on Compensation Insurance

 

Insurance Services Office



If you have questions about this webpage, please contact Edward C. Lanssens, 503-947-7742.